Aesthetic nurse injector Leslie Fletcher, RN, MEP-C, knows her way around a needle. She has worked with world-renowned, celebrity dermatologists and plastic surgeons who utilize dermal fillers such as Juvederm®, Restylane®, and Perlane® in their practices. Recognizing that these dermal fillers revolutionized how we address the signs of age, Leslie became determined to create a methodology that would maximize their potential. Well trained in medical science, including the bone, muscle, fat, and collagen structure that compose the facial armature, Leslie also looked into using the principles of architectural engineering, construction, and design for the rational to back her theories. These varied skills served as the foundation for her research and creation of the ArqueDerma Artistic Restoration Lift. Today, her patented technique is used by over 400 licensed ArqueDerma™ practitioners in North America and worldwide each year.
Tell us a bit about your background. How did you become an expert in cosmetic injectables?
In 2001, a colleague told me of a position in a plastic surgery office. Within a short time of employment, I knew I had found my passion. In a relatively new industry, I was able to blend my nursing degree, artistic creativity, and innovation in a specialty that was hungry for new ideas. Becoming an expert occurred gradually over time as I pursued my craft with passion and zeal. I took advantage of everything available to me to cultivate my expertise as an injectable nurse. I went to every conference, training, read every journal, and watched every webinar possible that promoted this goal. When considering a new technique to overcome an aesthetic obstacle, the research and development started not on my patients, but on myself. Though most of these trials had a positive effect, others were not as successful, such as the one that produced a lopsided grin, and were eliminated from my collection of new techniques. Eventually my training, experience, trials, and errors led me to the point of wanting to convey my knowledge and experience to mentor other injectors. This filled the gap that I sensed when I was learning this emerging craft. Feeling confident in my knowledge, I began to work in the role as a mentor to others utilizing my training. I quickly realized there was a whole new dimension of knowledge yet to be revealed, especially as I began my interaction with practitioners in other countries and with other products available there.
What inspired you to create the ArqueDerma™ technique?
Simply stated, I was dissatisfied with the current methods available that were ‘filling’ and not ‘fixing.’ It was as if a ‘puffy’ Band-Aid was put on the problem, instead of fixing the underlying cause. Patients I had been treating for years wanted more than just a ‘fill,’ they wanted a ‘lift.’ They believed in me, even before I believed in me. Comments were made such as, “You’re so creative, can’t you move this part of my face from down here to where it used to be?” This inspired my curiosity to look outside the box to fix this gravitational problem. With the highest regards to outcomes, I wanted to be able to offer my patients what they needed in a non-surgical way. I held to my standards, and postulated there must be a way to deliver those results to my patients. Similar to most inventions, ArqueDerma™ was born out of a necessity.
What sort of injectables do you use with the ArqueDerma™ technique?
All of the current FDA approved hyaluronic acids work beautifully for this technique, hydrating the skin, stimulating collagen, as well as suspending the lax tissue. Even though all of the hyaluronic acids work for the technique, I am determined to quantify certain aspects about the various hyaluronic acids that I see as advantageous to this technique. In order to do this, I have commissioned an independent research lab to study the characteristics of the various hyaluronic acids, such as Juvederm®, Perlane® and Restylane®. My primary goal is to determine which product has the greatest hydrating effect, as well as the optimum lift capacity. I hope to reveal the results of these various laboratory studies soon.
Who practices the technique and how can they learn about it?
Because of the patent, only practitioners licensed in ArqueDerma™ can perform, and market themselves as a licensed ArqueDerma™ practitioner. We take the training of this revolutionary technique very seriously. In order to acquire a license one must participate in an intense 8-hour training course with hands on coaching using the technique on a live patient. This technique is so different, and counterintuitive that it takes this type of intense training to grasp a hold of it. Currently we have over 400 practitioners in 6 different countries licensed in the technique. The trainings are held in various parts of the world, based on request. Information about upcoming trainings can be found at ArqueDerma.com.
What three questions should a patient ask a medical professional before having filler or toxin injections?
Medical aesthetics is an exciting and busy space, making finding a trusted individual to treat you challenging. I think word of mouth is certainly important and one should always make sure who they visit has a current license. Here are a few important questions I suggest patients ask to get the outcome they desire:
- When was the last training they attended? Medical aesthetics is a very dynamic, and relatively new industry. Your practitioner should be staying abreast of all the advancements in techniques that have occurred since this industry’s inception.
- What is their specialty? Do they offer a vast menu of treatments? Are they focused on mastering the art of injectables?
- What is their design aesthetic? Do you and your practitioner have a similar view of beauty, and a similar plan to get you to your goals and desired outcomes?
What is next in the field of cosmetic injectables? Are there any new products coming down the pipeline that you are particularly excited about?
I am very excited about a product that is already approved in Europe, and should arrive here next year sometime. Allergan’s newest hyaluronic acid named Voluma® is thicker, and more substantial, than its younger siblings Juvederm® Ultra, and Ultra plus. I have been privileged to test this product out, and have included it in some of my independent research. I’m also very anxious to see a topical alternative to Botox® make its way through clinical trials. I think there will be great indications for a more superficially administered type of neuromodulator to enhance the skin, tighten the pores, decrease sebum production, as well as redness and flushing all without the hassle of needles. In addition to products, I believe there are many more innovations with techniques to be discovered in aesthetic medicine. All it takes is a little creativity and the courage to try something a little outside the box.
Meet the Director of Medical Aesthetics
Anushka Spa, where Palm Beach ladies and jetsetters go to get pampered and treated, boasts 12,000 square feet of spa, salon, cosmedical center and a world renowned cellulite clinic. Tatler Magazine named it one of the top 10 medspas in the world! Dr. Bonnie Marting heads up the medical aesthetics practice by staying on the cutting edge of cosmetic dermatology to keep her well-heeled clientele coming back for more.
When did you enter the cosmetic dermatology field? At that time, what was the biggest trend in cosmetic dermatology and how has it changed since in your professional experience?
1996. At that time Botox was becoming a staple in the field, and bovine collagen was sill gaining in popularity. Other collagens, such as cadaver collagen, were in the works. IPL was becoming standard as the “Photo Derm” from ESC (at that time) emerged and was touted to treat many more things than it actually could. Different collagens came out, but nothing changed the filler world like the emergence of first Restylane in 2003, then Radiesse (then “Radiance”) in 2004.
What are the biggest trends now?
Today a huge trend is volumization. When done appropriately, re-adding volume can remove 10 to 15 years. Despite what we have seen in some movie stars, the trend is for soft, subtle, young, and fresh.
What characterizes the Palm Beach aesthetic patient in terms of aesthetic sensibility, wants, needs, preferences?
Here in Palm Beach there is a mixed bag. Those who are aesthetically sensible go for the soft, fresh, rested look and strive for healthy skin. Often my patients come in wanting fillers or enhanced lips and frequently add the phrase “but I’ve seen what’s out there and I don’t want that!” This invariably refers to those who have received platypus-like lips, sky-high eyebrows, and chipmunk-esque cheeks. I too have seen this out there. My patients typically want to look fab but natural. And often they don’t tell their husbands or significant others, so it must be subtle.
Tell us about your new book, Skin Secrets Doctors Save For Celebrities.
Skin Secrets Doctors Save for Celebrities is a compilation of all the education I provide daily to my patients depending upon their needs. There are so many treatments and products that are truly evidence-based and work wonders. There are so many more that really don’t do anything. It can be quite confusing. Most of the celebrities I see have been educated at least partially about what really works and many other patients have not. That is why the title was developed. The book is easy to read and understand and can be downloaded free from yearserased.com or if they prefer I give my patients the audio version. People are so grateful for the truth.
Which treatments/procedures do you think really have staying power?
From the results obtained with Sculptra, I truly believe this product will continue to explode. As new techniques and uses continue to emerge, one may never need have surgery! Additionally, the HA’s will always be around since they really fill lips and wrinkles nicely, and have the ability to be removed with hyaluronidase in the unlikely event of an adverse reaction or poor placement from an inexperienced injector. Finally, neurotoxins are going nowhere. As formulations continue to advance the popularity will continue to increase…if that is possible. Even in the down-turned economy, folks won’t skip their mortgage to get their Botox but they will skip a few nights out for dinner.
Please tell us about your partnership with the prestigious Anushka Spa.
I had the distinct pleasure of joining the Anushka team in 2004. Immediately I recognized that I had found home. First there was Anushka herself, who had studied and devoted over 3 decades to the treatment of cellulite, and to the treatment of the self-esteem. then there were the other partners, including Janice Worth, that led me to the understanding that I was with people in my league. I had not matched this with teams before. It was refreshing, and welcoming.
Are you a mom?
I am a step-mom and a grandmother. While the grandkids, all born after I married into the family, call me Bon-Bon, they are my kids. They are wonderful, and have my undivided time whenever they want it. Which is often.
What’s in your bag?
As an evidence-based practitioner, my first product I would not want to be without is my retinoid. I currently use tretinoin (generic Retin-A), but all the retinoids are good. Retinols are not as strong. The retinoids will keep you young forever. Second, of course, is my TIZO sunscreen, since tretinoin makes your skin actually younger, it is more susceptible to the sun. Finally, an antioxidant like Revale Night Cream to fertilize my skin and keep away the free radicals.
What’s your favorite bag?
My favorite bag? Because I tend to carry everything I think I may need with me (not a good practice and one I do not encourage) I really love the Prada Saffiano & Tessuto Tote. It can act as a large bag, or carry my life. Which it does. And it is sturdy, as I hate inconvenience and if something breaks, I am inconvenienced!
Meet the Skincare Chemist
With an educational background in pharmacy and chemistry and a career dedicated to dermatology and skincare, Barbara is Vice President, Technology & Clinical Evaluations at NeoStrata Company, Inc. She is responsible for the clinical programs to support the NeoStrata®, NeoCeuticals®, Exuviance® and CoverBlend® skin care brands. She also guides technical development and commercialization of the company’s patented skincare technologies, including the revolutionary alpha-hydroxy acids (AHAs), polyhydroxy acids, bionic acids and the emerging aminosugars.
What makes hydroxy acids so useful for maintaining skin health?
I am a huge fan of hydroxy acids. Having worked with them in clinical studies for many years at NeoStrata, I am convinced of their exceptional benefits, and don’t go a day without using them. While many other ingredient technologies target improvement of one aspect of skin, the hydroxy acids benefit all of the layers of skin, having multiple effects including increased cell turnover (making skin softer and brighter), and increased thickness and health of the epidermal layers with more even distribution of skin pigment (giving skin a healthy tone and texture). To target fine lines and wrinkles and increase skin firmness, hydroxy acids build volumizing components in skin. The hydroxy acids, including the alpha and poly hydroxy acids, provide consistent and predictable anti-aging effects to skin. Studies prove it!
What are your personal desert island beauty products?
My must-have products are a foaming cleanser, a daytime anti-aging moisturizer with sunscreen and a repairative night cream. It’s probably no surprise that I use Exuviance products: Purifying Cleansing Gel, Essential Daily Defense Fluid SPF 15 and Evening Restorative Complex. For added sunscreen protection, I like Neutrogena Ultra Sheer Dry Touch Sunblock, and I always have something on my lips to keep them hydrated – lip balm or gloss. I currently have Burt’s Bees Lip Shimmer, MAC frost lipstick and Nivea Kiss of Moisture in my bag. For makeup, I never miss wearing mascara – L’Oreal Lash Out is my favorite.
Which of the products that you have developed for NeoStrata are you most proud of and why?
I am most proud of developing some of NeoStrata’s newer anti-aging ingredients, including the bionic acids (e.g., lactobionic acid) and NeoGlucosamine. The bionic acids are in the alpha-hydroxy acid family, but they offer many additional benefits over traditional AHAs (glycolic acid, lactic acid, etc.) because they are gentle enough to be used on sensitive skin, after cosmetic procedures and around the eyes. NeoStrata has several products that contain the bionic acids – the one I am most proud of is the Exuviance Ultra Restorative Crème, which is a high strength formulation that is non-irritating (it is the same as saline solution in irritation tests!). It’s a highly moisturizing product that can be used on all types of sensitive skin. NeoGlucosamine firms skin and increases skin clarity. Check it out in Exuviance Sheer Refining Fluid, SPF 15.
What is going to be the future of skin care?
As we look around at the cosmetic product landscape, we are starting to see combination products that merge various benefit ingredients in one product or product regimen. For example, a peptide that targets increased collagen may be combined with a retinoid to target other aspects of the aging process in skin. This is a concept that NeoStrata believes in wholeheartedly and is embracing in new product offerings.
Are you a mom?
I am a mom! And I love it. I have a son in middle school and a daughter in elementary school, and they keep me very busy with sports and Girl Scouts and many other activities.
What’s your favorite bag?
Since my closet is full of them, I guess I’d have to say my favorite bag is a Coach bag. I am currently carrying a boxy, tan leather Coach bag with silver buckles. My favorite was the blue Coach Signature Stripe reversible tote. That reminds me, it’s time to get that bag out again!